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Ali A, Bielory L, Dotchin S, Hamel P, Strube YNJ, Koo EB. Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape. Surv Ophthalmol 2023:S0039-6257(23)00138-8. [PMID: 37890678 DOI: 10.1016/j.survophthal.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.
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Affiliation(s)
- Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Leonard Bielory
- Departments of Medicine, Allergy, Immunology and Ophthalmology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Stephanie Dotchin
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamel
- CHU Ste-Justine, Université de Montréal and McGill University Health Center, Montréal, Québec, Canada
| | - Yi Ning J Strube
- Department of Ophthalmology, Queen's University/Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Euna B Koo
- Stanford Byers Eye Institute, Palo Alto, California, USA
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CLEAR - Contact lens complications. Cont Lens Anterior Eye 2021; 44:330-367. [DOI: 10.1016/j.clae.2021.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
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Profile of tear lipid mediator as a biomarker of inflammation for meibomian gland dysfunction and ocular surface diseases: Standard operating procedures. Ocul Surf 2020; 26:318-327. [PMID: 33022413 DOI: 10.1016/j.jtos.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
Human tear is a biological fluid rich in lipids that is increasingly collected in clinical and biological research. The repertoire of small lipids or lipid mediators (often termed eicosanoids or oxylipins) found in human tear provides insight into metabolism of fatty acids and physiology of the ocular surface and Meibomian glands. Disturbances in the tear lipid mediators profile also occur during inflammation of the ocular surface that is not directly linked to lipid metabolism. The changes in the levels of pro-inflammatory and pro-resolution lipid mediators in the tear help assess the severity and stage of inflammation in ocular surface tissues. Mass spectrometry, used in the evaluation of tear lipid mediators, is an emerging tool in clinical diagnostics and personalized medicine. Here we describe the reproducibility, accuracy, and precision of quantifying lipid mediators in human tears, with a suggested method for tear collection and sample handling. The ranges of lipid mediators concentrations in tear fluid of healthy and diseased individuals with Meibomian gland dysfunction are reported, as well as the impact of age and disease on individual lipid mediators. We would like to recommend a set of guidelines, which can be further discussed in workshops. This will facilitate harmonization of future tear lipid mediators data across different instrument platforms in various laboratories. We hope that other fields requiring lipid mediators assays will also benefit from such an effort.
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Giant papillary conjunctivitis: A review. Ocul Surf 2020; 18:396-402. [DOI: 10.1016/j.jtos.2020.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/29/2020] [Indexed: 11/23/2022]
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Yang M, Bair JA, Hodges RR, Serhan CN, Dartt DA. Resolvin E1 Reduces Leukotriene B4-Induced Intracellular Calcium Increase and Mucin Secretion in Rat Conjunctival Goblet Cells. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1823-1832. [PMID: 32561135 DOI: 10.1016/j.ajpath.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023]
Abstract
Leukotriene B4 (LTB4) is a major proinflammatory mediator important in host defense, whereas resolvins (Rvs) are produced during the resolution phase of inflammation. The authors determined the actions of both RvE1 and RvD1 on LTB4-induced responses of goblet cells cultured from rat conjunctiva. The responses measured were an increase in the intracellular [Ca2+] ([Ca2+]i) and high-molecular-weight glycoprotein secretion. Treatment with RvE1 or RvD1 for 30 minutes significantly blocked the LTB4-induced [Ca2+]i increase. The actions of RvE1 on LTB4-induced [Ca2+]i increase were reversed by siRNA for the RvE1 receptor, and the actions of RvD1 were reversed by an RvD1 receptor inhibitor. The RvE1 and RvD1 block of LTB4-stimulated increase in [Ca2+]i was also reversed by an inhibitory peptide to β-adrenergic receptor kinase. LTB4 and block of the LTB4-stimulated increase in [Ca2+]i by RvE1 and RvD1 were partially mediated by the depletion of intracellular Ca2+ stores. RvE1, but not RvD1, counterregulated the LTB4-induced high-molecular-weight glycoprotein secretion. Thus, both RvE1 and RvD1 receptors directly inhibit LTB4 by phosphorylating the LTB4 receptor using β adrenergic receptor kinase. RvE1 receptor counterregulates the LTB4-induced increase in [Ca2+]i and secretion, whereas RvD1 receptor only counterregulates LTB4-induced [Ca2+]i increase.
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Affiliation(s)
- Menglu Yang
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey A Bair
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Robin R Hodges
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Brigham and Women's Hospital and Department of Anaesthesia, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts
| | - Darlene A Dartt
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Hirakata T, Matsuda A, Yokomizo T. Leukotriene B 4 receptors as therapeutic targets for ophthalmic diseases. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158756. [PMID: 32535236 DOI: 10.1016/j.bbalip.2020.158756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022]
Abstract
Leukotriene B4 (LTB4) is an inflammatory lipid mediator produced from arachidonic acid by multiple reactions catalyzed by two enzymes 5-lipoxygenase (5-LOX) and LTA4 hydrolase (LTA4H). The two receptors for LTB4 have been identified: a high-affinity receptor, BLT1, and a low-affinity receptor, BLT2. Our group identified 12(S)-hydroxy-5Z,8E,10E-heptadecatrienoic acid (12-HHT) as a high-affinity BLT2 ligand. Numerous studies have revealed critical roles for LTB4 and its receptors in various systemic diseases. Recently, we also reported the roles of LTB4, BLT1 and BLT2 in the murine ophthalmic disease models of mice including cornea wound, allergic conjunctivitis, and age-related macular degeneration. Moreover, other groups revealed the evidence of the ocular function of LTB4. In the present review, we introduce the roles of LTB4 and its receptors both in ophthalmic diseases and systemic inflammatory diseases. LTB4 and its receptors are putative novel therapeutic targets for systemic and ophthalmic diseases.
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Affiliation(s)
- Toshiaki Hirakata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, Japan; Department of Biochemistry, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, Japan
| | - Akira Matsuda
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, Japan
| | - Takehiko Yokomizo
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, Japan.
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Havuz E, GÜdÜl Havuz S. Rare Presentation of Severely Limited Granulomatosis With Polyangiitis Manifesting With Orbital Wall Destruction: Literature Review and Case Report. Arch Rheumatol 2020; 35:292-299. [PMID: 32851382 DOI: 10.46497/archrheumatol.2020.7503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022] Open
Abstract
Necrosis resulting from mechanical local factors can be seen in patients with granulomatosis with polyangiitis (GPA) even in remission. GPA can cause serious morbidity even when limited. An ocular prosthesis that increases inflammation and damages local circulation should be used very carefully in such patients. In this article, we report a 68-year-old male patient who was diagnosed with localized GPA 11 years ago and referred to our clinic with the complaint of displacement of an ocular prosthesis inside the nose and epistaxis. Four years ago, the left eye was enucleated because of pain and vision loss. Two months after the enucleation, the patient began to use an ocular prosthesis. Orbital medial wall destruction developed while the patient was receiving maintenance therapy that consisted of cyclophosphamide (150 mg/day) plus prednisolone (32 mg). When the ocular prosthesis was displaced in the nasal cavity, the prosthesis was first removed and the patient was clinically stabilized. Later, orbital wall reconstruction was performed at another center.
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Affiliation(s)
- Erol Havuz
- Department of Ophthalmology, University of Health Sciences, SUAM Samsun Hospital, Samsun, Turkey
| | - Seda GÜdÜl Havuz
- Department of Microbiology, Public Health Institution of Turkey, Samsun, Turkey
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Hatamleh MM, Abbariki M, Alqudah N, Cook AE. Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1. J Craniofac Surg 2017; 28:1293-1296. [DOI: 10.1097/scs.0000000000003370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Masoudi S, Zhao Z, Willcox M. Relation between Ocular Comfort, Arachidonic Acid Mediators, and Histamine. Curr Eye Res 2017; 42:822-826. [DOI: 10.1080/02713683.2016.1255338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Simin Masoudi
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- The Vision Cooperative Research Centre, Sydney, Australia
| | - Zhenjun Zhao
- The Vision Cooperative Research Centre, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Kuraishi Y. Methods for preclinical assessment of antipruritic agents and itch mechanisms independent of mast-cell histamine. Biol Pharm Bull 2016; 38:635-44. [PMID: 25947907 DOI: 10.1248/bpb.b15-00090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Itch is a sensation that provokes a desire to scratch. Mast-cell histamine was thought to be a key itch mediator. However, histamine and mast-cell degranulation were reported not to elicit scratching in animals. It was difficult to investigate the pathophysiology of itching and to evaluate the antipruritic efficacy of chemical agents in the early 1990 s. We showed that hind-paw scratching and biting were elicited by stimulation with pruritogenic agents in mice. Those results demonstrated for the first time that cutaneous itching could be evaluated behaviorally in animals. We established various animal models of pathological itch of the skin (dry skin, mosquito allergy, surfactant-induced pruritus, and herpes zoster) and mucus membranes (pollen allergy). Mast-cell histamine did not play a key role in itching in any animal model examined except for the pollen allergy model. Histamine is not an exclusive itch mediator of mast cells; tryptase and leukotriene B4 released from mast cells also act as itch mediators. Epidermal keratinocytes release several itch mediators, such as leukotriene B4, sphingosylphosphorylcholine, thromboxane A2, nociceptin, nitric oxide, and histamine, which may play important roles in pathological itching. Appropriate animal models of pathological itching are needed for pharmacological evaluation of the antipruritic efficacy of chemical agents.
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Affiliation(s)
- Yasushi Kuraishi
- Laboratory of Applied Pharmacology, Graduate School of Medicine and
Pharmaceutical Sciences, University of Toyama
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Bonaque-González S, Amigó A, Rodríguez-Luna C. Recommendations for post-adaption care of an ocular prosthesis: A review. Cont Lens Anterior Eye 2015; 38:397-401. [PMID: 26142648 DOI: 10.1016/j.clae.2015.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/04/2015] [Accepted: 06/22/2015] [Indexed: 11/30/2022]
Abstract
An ocular prosthesis must be maintained in a suitable state of cleanliness, fit and preservation. Otherwise its functioning may be compromised, leading to a variety of diseases. However, there is a lack of consensus on the care of such prostheses. This review assembles and attempts to update existing knowledge in this area and discusses the most appropriate care regimes.
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Affiliation(s)
- Sergio Bonaque-González
- Instituto Oftalmológico Amigó, Santa Cruz de Tenerife, Spain; Departamento de Física, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - Alfredo Amigó
- Instituto Oftalmológico Amigó, Santa Cruz de Tenerife, Spain
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Liu M, Yokomizo T. The role of leukotrienes in allergic diseases. Allergol Int 2015; 64:17-26. [PMID: 25572555 DOI: 10.1016/j.alit.2014.09.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022] Open
Abstract
Leukotrienes (LTs), both LTB4 and the cysteinyl LTs (CysLTs) LTC4, LTD4 and LTE4, are implicated in a wide variety of inflammatory disorders. These lipid mediators are generated from arachidonic acid via multistep enzymatic reactions through which arachidonic acid is liberated from membrane phospholipids through the action of phospholipase A2. LTB4 and CysLTs exert their biological effects by binding to cognate receptors, which belong to the G protein-coupled receptor superfamily. LTB4 is widely considered to be a potent chemoattractant for most subsets of leukocytes, whereas CysLTs are potent bronchoconstrictors that have effects on airway remodeling. LTs play a central role in the pathogenesis of asthma and many other inflammatory diseases. This review will provide an update on the synthesis, biological function, and relevance of LTs to the pathobiology of allergic diseases, and examine the current and future therapeutic prospects of LT modifiers.
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Affiliation(s)
- Min Liu
- Department of Biochemistry, Juntendo University School of Medicine, Tokyo, Japan; Department of Respiratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Takehiko Yokomizo
- Department of Biochemistry, Juntendo University School of Medicine, Tokyo, Japan.
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Andoh T, Sakai K, Urashima M, Kitazawa K, Honma A, Kuraishi Y. Involvement of leukotriene B4 in itching in a mouse model of ocular allergy. Exp Eye Res 2012; 98:97-103. [PMID: 22504036 DOI: 10.1016/j.exer.2012.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/24/2012] [Accepted: 03/29/2012] [Indexed: 11/20/2022]
Abstract
Itching of ocular allergy is alleviated but not completely relieved by H(1) histamine receptor antagonists, suggesting that histamine is not the sole itch mediator in ocular allergy. We investigated whether leukotriene B(4) (LTB(4)), a mediator of cutaneous itch, is involved in the itch of ocular allergy in mice. Mice were immunized by the repeated subcutaneous injections of ragweed pollen and alum into the caudal back, and given a subconjunctival injection of ragweed pollen extract into the palpebra for allergic challenge. Challenge with ragweed pollen extract markedly elicited ocular scratching in sensitized mice. The scratching was almost abolished by mast cell deficiency. The H(1) antagonist terfenadine partially inhibited scratching at a dose that almost completely suppressed plasma extravasation. Scratching was inhibited by the glucocorticoid betamethasone and the 5-lipoxygenase inhibitor zileuton at doses that inhibited the challenge-induced production of LTB(4). A subconjunctival injection of LTB(4) at doses 1/10,000 or less than that required for histamine elicited ocular scratching in naïve mice. The LTB(4) receptor antagonist ONO-4057 inhibited the ragweed pollen challenge-induced ocular scratching at doses that suppressed LTB(4)-induced ocular scratching. In addition to histamine, LTB(4) is involved in the ocular itching of pollen allergy. H(1) receptor antagonists with an inhibitory effect on the action and/or production of LTB(4) may have more potent anti-pruritic activity than selective H(1) antagonists.
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Affiliation(s)
- Tsugunobu Andoh
- Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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Paranhos RMZF, Batalhão CH, Semprini M, Regalo SCH, Ito IY, de Mattos MDGC. Evaluation of ocular prosthesis biofilm and anophthalmic cavity contamination after use of three cleansing solutions. J Appl Oral Sci 2009; 15:33-8. [PMID: 19089097 PMCID: PMC4327209 DOI: 10.1590/s1678-77572007000100008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 02/22/2007] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED In addition to an initial socket discomfort, ocular prosthesis (OP) installation may allow the adherence of fungi and/or bacteria due to the superficial characteristics of the prosthesis' material, use of inadequate cleansing solutions and methods, or because the void located between the internal portion of the prosthesis and the anophthalmic cavity (AC) mucosa. OBJECTIVE The aim of this study was to evaluate OP biofilm formation and the level of contamination of the internal portion of the OP and the AC in 24 patients. MATERIAL AND METHODS Material was collected from the AC at the beginning of the study and 15 days after cleansing of the OP with 3 cleansing solutions: a neutral liquid soap, a multiuse solution for contact lens (Complete) and 0.12% chlorhexidine (Periogard). The collected materials were sowed in Petri dishes containing selective media for aerobic and facultative microorganisms, specifically staphylococci (Hipersalt agar with egg yolk), aerobic microorganisms (Brain Heart Infusion Blood Agar), streptococci (Mitis salivarius Agar), gram-negative bacilli (MacConkey Agar) and yeasts (Chromagar Candida), incubated at 35 degrees C or 37 degrees C and the number of colony forming units were counted. Data were analyzed statistically by ANOVA, Friedman's test and Spearman's correlation. RESULTS Aerobic microorganisms, gram-negative bacilli and S. aureus were found in the OP biofilm and in the AC. There was statistically significant difference (p<0.05) between the number of microorganisms before and after the use of the cleansing solutions. CONCLUSION There was positive correlation with respect to the microorganisms present in the OP biofilm and AC for the 4 proposed treatments, indicating that the decrease of OP contamination leads to AC contamination as well.
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Laengle UW, Markstein R, Pralet D, Seewald W, Roman D. Effects of latanoprost, timolol and GLC756, a novel dopamine D(2) agonist and D(1) antagonist on LTC(4) release after rat mast cell activation. Clin Exp Ophthalmol 2007; 35:645-50. [PMID: 17894685 DOI: 10.1111/j.1442-9071.2007.01560.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Mast cells participate in ocular allergic inflammation by releasing biologically active mediators. Leukotrienes are released from activated mast cells via an IgE-dependent mechanism, and play a crucial role in ocular allergic inflammation. In this study, the effect of three topical antiglaucoma drugs, that is, latanoprost, timolol and GLC756, a novel dopamine D(2) agonist and D(1) antagonist, on leukotriene C(4) (LTC(4)) release after rat mast cell activation was examined. METHODS A rat basophilic leukaemia RBL-2H3 mast cell line was activated via IgE/anti-IgE. Rat mast cells were incubated with latanoprost, timolol, or GLC756 at concentrations of 0.1, 1, 10 and 30 microM. LTC(4) concentration in supernatant was assessed 5 h post activation by EIA. RESULTS Compared with controls, timolol showed no relevant effect on LTC(4) release, 5 h after mast cell activation. Latanoprost and GLC756, in contrast, revealed an inhibitory effect on LTC(4) release, which was dose-related and statistically significant at the concentrations of 10 and 30 microM. CONCLUSION The results of this study suggest that timolol has no significant influence on LTC(4) release from activated mast cells. By contrast, latanoprost and GLC756 inhibited LTC(4) release, suggesting a possible anti-inflammatory effect on ocular allergic inflammatory processes in topical glaucoma medication.
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Affiliation(s)
- Ulrich W Laengle
- Department of Toxicology/Pathology, Novartis Pharma AG, Basel, Switzerland
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Abstract
The treatment of ocular allergy requires a better understanding of the spectrum of clinical disorders involving various components of the immune system, and of interactions at the conjunctival surface. The immune response focuses primarily on the different levels of activity of Th2 lymphocytes and various other immune cells associated with allergic disorders, including mast cells, eosinophils, fibroblasts, and epithelial and endothelial cells. Ocular allergic disorders include seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), giant papillary conjunctivitis (GPC) and atopic keratoconjunctivitis (AKC), which, through immunopathological and molecular immunological techniques, can all be better appreciated as being part of a larger spectrum of an atopic disease state. In SAC, pathological changes, such as increased mast-cell activation, the presence of migratory inflammatory cells, and early signs of cellular activation at the molecular level, are minimal. In PAC, these changes are more pronounced in line with the increased duration of allergenic stimulation. In more chronic forms of allergic conjunctivitis, such as VKC in children and AKC in adults, the following changes are evident: a persistent state of mast cell, eosinophil and lymphocyte activation; noted switching from connective-tissue to mucosal-type mast cells; increased involvement of corneal pathology; and follicular development and fibrosis. The treatment of acute and more chronic forms of allergic conjunctivitis has focused in the past on symptomatic relief of symptoms, but with a better understanding of the mechanisms involved we can now provide interventional therapeutic strategies and symptomatic relief. Our advances in the basic understanding of these conditions are providing the foundation for guidelines that improve the ocular health of patients with ocular allergies.
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Affiliation(s)
- Leonard Bielory
- UMDNJ, Asthma & Allergy Research Center, Immuno-Ophthalmology Service, New Jersey Medical School, Newark, New Jersey, USA.
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Swann PG. Giant papillary conjunctivitis associated with an ocular prosthesis. Clin Exp Optom 2001; 84:293-295. [PMID: 12366372 DOI: 10.1111/j.1444-0938.2001.tb05041.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2001] [Indexed: 11/28/2022] Open
Abstract
A case of giant papillary conjunctivitis associated with the wearing of an ocular prosthesis is described. Potential causes and treatment regimens are briefly reviewed.
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Affiliation(s)
- Peter G Swann
- School of Optometry, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia
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Abstract
PURPOSE To study the tear film clearance in contact lens associated papillary conjunctivitis patients. METHODS Fifty-eight daily-wear soft contact lens wearers completed a questionnaire regarding a survey of their contact lens usage and subjective symptoms. They were grouped according to the size of conjunctival papillae, namely PC1 with no papillae, PC2 with papillae of less than 0.3 mm, and PC3 with papillae of 0.3-1.0 mm in diameter. Tear film breakup time and fluorescein clearance tests were performed. RESULTS There was a median of 1, 2, and 3 subjective symptoms in PC1, PC2, and PC3 groups respectively (p < 0.001). Patients with larger papillae on their upper tarsus had more subjective symptoms such as burning sensation, discharge, limbal injection, foreign body sensation and dryness sensation (p = 0.018, 0.001, 0.004, 0.005, and 0.036 respectively). They also had shorter tear film breakup time (p = 0.05), delayed tear clearance (p = 0.002) and more corneal neovascularization (p < 0.001). Patients having delayed tear clearance test tended to have more subjective symptoms (p = 0.004) and larger papillae on upper tarsus (p = 0.002). However, neither the way the patients cleaned their contact lenses nor their enzyme cleaning frequency associated with the tear fluorescein clearance (p = 0.528 and 0.394, respectively). Meibomian gland dysfunction and corneal neovascularization did not correlate with the delayed tear clearance either (p = 0.111 and 0.717, respectively). CONCLUSIONS Tear clearance in contact lens associated papillary conjunctivitis patients was delayed. We proposed that delayed tear clearance might increase the protein and inflammatory mediator concentrations in the tear film and contribute to the pathogenesis or aggravate the severity of contact lens associated papillary conjunctivitis.
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Affiliation(s)
- S W Chang
- Department of Ophthalmology, Chang Gung University and Memorial Hospital, 5 Fu-Hsing St., Kwei-Shan Hsiang, Taoyuan, Taiwan 333.
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